About Zika Virus Disease
Zika virus was first discovered in 1947 and is named after the Zika forest in Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika were reported in tropical Africa, Southeast Asia, and the Pacific Islands. Zika outbreaks had probably occurred in many locations, but were undetected or unidentified. Before 2007, at least 14 cases of Zika had been documented, although other cases were likely to have occurred, likely to have been misdiagnosed and therefore were not reported.
Because the symptoms of Zika are similar to those of many other diseases, and until 2016 there was no known valid accurate clinical test for the virus, many cases may not have been recognized. It was first isolated from a rhesus monkey in the Zika forest, Uganda, in mosquitoes (Aedes africanus) in the same forest in 1948 and in humans in Nigeria in 1954. Zika virus is endemic in parts of Africa and Asia and was first identified in the South Pacific after an outbreak on Yap Island in the Federated States of Micronesia in 2007.
Zika virus is an emerging mosquito-borne virus first identified through a monitoring network of sylvatic yellow fever. It was subsequently identified in humans in 1952 first in Uganda and then the United Republic of Tanzania, then Nigeria. Outbreaks of Zika virus disease have now been recorded in Africa, North America and South America, Asia and the Pacific, and many Island Nations around the globe.
Zika virus is transmitted by the same type of mosquito that carries dengue fever, yellow fever, and chikungunya virus. A mosquito bites an infected person and then passes those viruses to other people it bites. Outbreaks did not occur outside of Africa until 2007, when it spread to the South Pacific.
The virus is of the Genre: Flavivirus; Vector: Aedes mosquitoes (which usually bite during the morning and late afternoon/evening hours) and Reservoir: Unknown.
Zika virus is a flavivirus, closely related to dengue. For almost 50 years, cases of Zika virus in humans had previously been reported in Africa, southern Asia and the Pacific Islands. Beginning in 2014, however, Zika virus outbreaks have occurred throughout the tropical and sub-tropical areas of the western hemisphere, as far north as Mexico and Puerto Rico. Now in 2016 cases have been officially reported as far north as Canada and the European continent. It is also known that Zika, dengue and chikungunya viruses are transmitted by mosquitoes mostly active during daytime, it's important that all travelers visiting affected areas continue to take protective measures to prevent mosquito bites throughout the day.
Zika virus infection is symptomatic in only about 1 out of every 5 cases. When symptomatic, Zika infection usually presents as an influenza-like syndrome, often mistaken for other arboviral infections like dengue or chikungunya. This necessitates the need for a treatment that will not harm patients who are misdiagnosed.
CDC Director Tom Frieden, MD, first told reporters that “on occasion,” it may be spread through sexual contact or blood transfusions. In early February, 2016, a case of Zika spreading through sexual contact was reported in Dallas County, Tex. There, a person who'd traveled to an area that had cases of the virus infected a partner who had not traveled.
The CDC is aware of a report that Brazilian scientists have found the virus in the saliva and urine of infected people, Frieden said, but more definite information is needed.
Another similar mosquito, Aedes albopictus, also has the potential to transmit Zika virus, but has only been found in Australia, in the Torres Strait. These mosquito vectors typically breed in domestic water-holding containers; they are daytime biters and feed both indoors and outdoors near dwellings.
In French Polynesia, after a local Zika virus outbreak in 2013 and 2014, an increase in autoimmune and neurological diseases, such as, Guillain-Barré, had been observed. At this time, there is no proven link at this stage other than this temporal association. The simultaneous circulation of dengue serotype 1 and 3 viruses may also play a role.
Pathway of Virus in Mosquito
Infected blood travels to the midgut. Mosquito feeds on virus-infected blood. Virus enters the circulatory system. From there it travels to the salivary glands. Mosquito bites again, injecting virus-infected saliva into victim before feeding.
Only female mosquitoes bite people: they need blood in order to lay eggs. They pick up the virus in the blood. It travels from their gut through their circulatory system to their salivary glands and is injected into its next human victim. Mosquito saliva contain proteins that keeps blood from clotting. When a mosquito bites it first injects saliva so that its prey's blood does not clog its straw-like proboscis.
The Zika virus is also related to dengue, yellow fever and West Nile virus. After being discovered in the Zika forest in Uganda (1947) it remained confined to Africa and Asia and did not begin spreading widely in the Western Hemisphere until last May 2015, when an outbreak occurred in Brazil.
Until very recently (2015-2016), almost no one on the Western world had been infected. Few people here have any natural immune defenses against the virus, so it is spreading rapidly. Millions of people in tropical regions of the Americas may now have been infected.
Symptoms of the Zika Virus
The Zika virus disease is caused by the Zika virus that is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness was originally thought to be mild with symptoms lasting for several days to a week after being bitten by an infected mosquito. People were thought not to be sick enough to go to the hospital, and few very rarely die of Zika. For these reasons, many people might not have realized that they had been infected. It was also believed that once a person has been infected, he or she is likely to be protected from future infections. It is now known that largely all of the above assumptions are incorrect.
The incubation period, the time from exposure to symptoms, of Zika virus disease is not exactly clear; there is not always a tell-tale mark or sign from the bite, but is likely to be a few days. The symptoms are similar to other arbovirus infections such as dengue, and include fever, skin rashes, conjunctivitis, muscle and joint pain, malaise, and headache. These symptoms are usually mild and last for 2-7 days.
During large outbreaks in French Polynesia and Brazil in 2013 and 2015 respectively, national health authorities reported potential neurological and auto-immune complications of Zika virus disease. Recently in Brazil, local health authorities have observed an increase in Guillain-Barré syndrome which coincided with Zika virus infections in the general public, as well as an increase in babies born with microcephaly in northeast Brazil. Agencies investigating the Zika outbreaks are finding an increasing body of evidence about the link between Zika virus and microcephaly. However, more investigation is needed to better understand the relationship between microcephaly in babies and the Zika virus. Other potential causes are also being investigated.
The disease can cause fever, rash, joint pain, and conjunctivitis, also called pinkeye. But most people won't know they have it. “Only about 1 in 5 people with the virus will exhibit symptoms,” says Amesh Adalja, MD, a spokesman for the Infectious Diseases Society of America. “The vast majority have no symptoms at all.” Adalja also says the virus rarely causes major complications. “It's never been thought of as a severe infectious disease until now.”
In rare cases, Zika has been associated with Guillain-Barré syndrome, a disorder that can cause partial or complete paralysis, most often temporary but in some cases life-long. An increase in that illness has been seen in areas such as French Polynesia and Brazil, where a Zika epidemic has taken place, but research hasn't established a direct relationship between the two, according to the WHO's Regional Office for the Americas.
One case of Guillain-Barre that may be tied to Zika has been reported to the CDC, Frieden said. But “it's very challenging to make the link in an individual case,” he said, as Guillain-Barre can also follow the flu or other infections.
Zika and other mosquito-borne illnesses, such as dengue fever, chikungunya, and West Nile virus cause a variety of flu-like symptoms that range in severity and can last from a few days to more than a week. As with Zika, some people infected with dengue or West Nile will not show any symptoms.
General Symptoms:
About 1 in 5 people infected with Zika virus become ill (i.e., develop Zika). The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period, the time from exposure to symptoms, for Zika virus disease is not known, but is likely to be a few days to a week.
The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito, however progression of the disease appears to be occuring with the greater numbers of those infected.
People usually don't get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected. Zika virus usually remains in the blood of an infected person for about a week but it can be found longer in some people.
Once a person has been infected, he or she is not likely to be protected from future infections.
Symptons also include, low-grade fever (between 37.8° C. and 38.5° C.), arthralgia, notably of small joints of hands and feet, with possible swollen joints. Myalgia, headache, retro-ocular headaches. Conjunctivitis, cutaneous maculopapular rash, post-infection asthenia which seems to be frequent.
More rarely observed symptoms include digestive problems, such as, abdominal pain, diarrhea, constipation, mucous membrane ulcerations (aphthae), and pruritus.
Zika virus infection generally causes a non-severe disease with the possible exception of the effects to the fetus in pregnant women. Thus, pregnant women or women who may become pregnant are advised to take precautions. Immediately see a healthcare provider if you are pregnant and develop a fever, rash, joint pain, or red eyes within two weeks after traveling to a place where Zika has been reported. Be sure to tell the health care provider where you traveled.
As Zika infection may cause a rash that could be confused with other diseases such as measles or dengue, these more serious diseases need to be ruled out. Diagnosis of Zika infection will firstly be by exclusion, based on symptoms, travel history and exclusion of other diseases including measles and dengue.
Transmission
Specific areas with ongoing Zika virus transmission are often difficult to determine and are likely to change over time. Global climate changes are affecting the spread of the mosquito vectors and the virus is likely to be found in areas that have never had Aedes mosquitoes before. The CDC Travelers Health Site with the most updated travel information for those going to areas that are declared epidemic for Zika.
Diagnosis and Public Reporting
Zika virus infection should be considered in patients with acute onset of fever and polyarthralgia, especially travelers who recently returned from areas with known virus transmission.
The differential diagnosis of Zika virus infection varies based on place of residence, travel history, and exposures. Dengue and chikungunya viruses are transmitted by the same mosquitoes and have similar clinical features. The two viruses can circulate in the same area and can cause occasional co-infections in the same patient. Chikungunya virus infection is more likely to cause high fever, severe arthralgia, arthritis, rash, and lymphopenia, while dengue virus infection is more likely to cause neutropenia, thrombocytopenia, hemorrhage, shock, and death. It is important to rule out dengue virus infection because proper clinical management of dengue can improve outcome. In addition to dengue, other considerations include leptospirosis, malaria, rickettsia, group A streptococcus, rubella, measles, parvovirus, enteroviruses, adenovirus, other alphavirus infections (e.g., Mayaro, Ross River, Barmah Forest, O'nyong-nyong, and Sindbis viruses), post-infections arthritis, and rheumatologic conditions.
Preliminary diagnosis is based on the patient's clinical features, places and dates of travel, and activities. Laboratory diagnosis is generally accomplished by testing serum or plasma to detect virus, viral nucleic acid, or virus-specific immunoglobulin M and neutralizing antibodies.
Zika virus disease is a nationally notifiable condition. Healthcare providers are encouraged to report suspected Zika cases to their state or local health department to facilitate diagnosis and mitigate the risk of local transmission in many other countries and territories. Zika virus likely will continue to spread to new areas.
Global Concern
In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. On Feb. 1, 2016, the World Health Organization (WHO) declared Zika virus a Public Health Emergency of International Concern (PHEIC) regarding a recent cluster of microcephaly cases and other neurological disorders and the possible association of these illnesses with Zika virus infections. The WHO recommended efforts towards improved surveillance of and education regarding Zika virus as well as promotion of mosquito control. The WHO recommended no restrictions on travel or trade. Unfortunately, mosquito control has never been very effective, and given the sheer numbers of them and their longevity throughout the Earth's species; there is little chance of this option being worthwhile.
The WHO says Zika virus is “spreading explosively” in the Americas. Because it's been linked to birth defects in babies born to pregnant women, the CDC has issued travel warnings for pregnant women in countries where the disease has been found. Zika was thought to be primarily mosquito-borne, although now confirmed cases of sexual transmission have been reported.
As many as four million people could be infected by the end of the year. Officials at the Centers for Disease Control and Prevention have urged pregnant women against travel to about two dozen countries, mostly in the Caribbean and Latin America, where the outbreak is expanding exponentially. The infection appears to be linked to the development of unusually small heads and brain damage in newborns. Pregnant women who have been to these regions should be tested for the infection, the agency said.
Treatment
There are no specific treatments for Zika. There is no vaccine currently available. Zika is treated symptomatically, usually with bed rest, fluids, and medicines to relieve symptoms of fever and aching such as ibuprofen, naproxen, acetaminophen, or paracetamol. Aspirin should be avoided. Infected persons should be protected from further mosquito exposure during the first few days of the illness so they can not contribute to the transmission cycle.
As with the majority of mosquito-borne viral infections, there is no specific antiviral treatment for Zika virus however, it is important to exclude other, more serious infections for which there is targeted treatment or alternative clinical interventions available, including malaria and dengue virus, respectively.
Treatment of patients with Zika virus infection is entirely supportive, requiring rest, fluids, and pain and fever management. Individuals who have persistent joint pain may require additional supportive care including corticosteroids and/or physiotherapy.
Unfortunately, chloroquine is gaining ground as a possible treatment for the symptoms associated with Zika, and as an anti-inflammatory agent to combat the arthritis associated with Zika virus. A University of Malaya study found that for arthritis-like symptoms that are not relieved by aspirin and non-steroidal anti-inflammatory drugs (NSAID), chloroquine phosphate (250 mg/day) has given promising results. There is a debate about the appropriateness of chloroquine as treatment for Zika. Unpublished studies in cell culture and monkeys show no effect of chloroquine treatment on reduction of Zika disease.
Incorporated herein by reference is U.S. Pat. No. 9,011,892, Artemisinin with Berberine Compositions and Methods of Making, issued Apr. 21, 2015 to the present inventor; U.S. Pat. No. 9,011,892 demonstrated and listed ad nauseam, the ill side effects, psychological and physical dangers of using quinine and its many derivatives. Once again, primarily due to its low cost, remaining high stock counts, and the wrongful but familiar use for many years, we seem to be content to deal with a devil we know rather than expand our knowledge and build a better remedy.
Thus, there is need for a therapeutically effective treatment for humans and animals infected with the Zika virus disease. An antiviral treatment is provided by the Artemisinin Combination Therapy (ACT) of the present invention that includes artemisinin, derivatives of artemisinin, berberine, capsaicin and Tinospora Cordifolia for treatment of Zika virus.